Category: Access to Care

Senate Majority Leader Mitch McConnell said “everybody” in the Senate wants to preserve consumer protections for people with pre-existing conditions, an Obamacare provision that the Trump administration last week said is unconstitutional and should be struck down in court.

“Everybody I know in the Senate — everybody — is in favor of maintaining coverage for pre-existing conditions,” McConnell told reporters in the Capitol. “There is no difference in opinion about that whatsoever.”

Health and Human Services Secretary Alex Azar told lawmakers Tuesday that he wants to preserve access to affordable insurance for Americans with preexisting medical conditions, but he declined to disclose his view of an administration move that could undercut such consumer protections.

Calling it “a constitutional position . . . not a policy position,” Azar sidestepped grilling on whether he agreed with a legal brief filed last week by Justice Department attorneys stating they would not defend the Affordable Care Act in a federal lawsuit by Texas and 19 other Republican-led states.

People with ACA plans drop their plans at a much higher rate than in the pre-Obamacare era. The average monthly attrition rate under Obamacare in 2015 (3.6%) was nearly two-thirds higher than the average monthly attrition rate in the non-group market in 2006 (2.2%). This occurred even though 86% of Obamacare enrollees were receiving subsidized coverage. We can only imagine what would have happened had enrollees borne the full cost of their premiums (as was the case in 2006). The reality is that while the non-group market was never perfect, it performed much more smoothly before the ACA than most critics ever gave it credit.

Here’s a simple idea to help lower health-care costs: publish prices. A bipartisan group of state lawmakers in Colorado is pushing a bill to do precisely that. The Comprehensive Health Care Billing Transparency Act would allow Coloradans to see the true price of any health service they use—exams, procedures, prescriptions—before they undertake treatment.

Finally, we have good news on health care reform coming out of the nation’s capital.

In October 2017, President Trump issued an executive order calling for more consumer choices in the health insurance market. The departments of Health and Human Services, Labor and the Treasury responded by taking aim at an Obama administration policy that severely limits the flexibility of a coverage option called “short-term, limited-duration insurance plans.”

Insurer participation and competition in Obamacare declined again in 2018 at both the state and county levels. In 2017, nearly one-third of counties (32.8 percent) had only one insurer offering exchange coverage. In 2018, more than half (51.3 percent) of all counties face that situation. Many insurers have exited the exchanges; ones that remain offer higher premiums and narrow network plans. The emerging norm appears to be one in which major metropolitan areas have two or three insurers offering exchange coverage, while less-populous areas have only one. A health insurance monopoly offering overly expensive coverage that pays for only a very limited set of providers is deeply unattractive, especially to customers who previously enjoyed choice in both their insurance and medical care. Not surprisingly, consumers are looking to Congress and the President for help in escaping the soaring costs and shrinking choices that characterize the ACA exchanges.

New analysis from Avalere finds that plans with more restrictive networks, including health maintenance organizations (HMOs) and exclusive provider organizations (EPOs), continue to dominate the exchange market, with 73% of the 2018 market comprised of restrictive network plans, up from 68% in 2017 and 54% in 2015. Avalere analysis also found that deductibles for the most popular type of plan on the exchange—silver plans—will climb in 2018, to an average of $3,937, up from $3,703 in 2015, and each following year they will increase.
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People who bought policies from Centene, a large for-profit health insurance company, filed a federal lawsuit on Thursday claiming the company does not provide adequate access to doctors in 15 states. “Members have difficulty finding–and in many cases cannot find–medical providers,” who will accept patients covered under policies sold by Centene, according to the lawsuit filed in federal court in Washington State.

“People signed up for insurance and they ‘discovered there were no doctors,”’said Seth Lesser, a partner at the law firm of Klafter Olsen & Lesser who is representing some of the policyholders.

“The Trump administration’s action today is cruel,” said Democratic Congressman Frank Pallone Jr. of New Jersey. The new policy is “the latest salvo of the Trump administration’s war on health care,” according to a health-care advocacy group. “The pain is the point” of the policy, wrote columnist and economist Paul Krugman.

They were attacking the Trump administration’s decision last week to allow states to impose work requirements on Medicaid beneficiaries. But far from being a “cruel” action designed to inflict “pain” on the vulnerable, the administration’s decision is completely reasonable.

The Trump administration is estimating there are now only 700 issuers in the individual and small group markets, which is down from 2,400 in an earlier estimate.

The CMS cited the updated figure in an information collection notice posted Jan. 8. The agency is seeking permission from the White House’s Office of Management and Budget to continue collecting data annually from exchange plans about their enrollees’ risk profiles.

In an earlier version of the request submitted to the executive branch last month, the agency estimated there were 2,400 issuers in the individual and small group markets.